Key result
Digital health interventions reduce all-cause hospitalizations ~27% vs. standard care in heart failure.
Why the study?
Digital health modalities have been developed to improve heart failure care, but little is known about their impact on hospitalization and mortality in low-and-middle income countries.
Do digital health interventions reduce hospitalization and mortality in heart failure patients in low- and middle-income countries?
Meta-Analysis (n=4,568)
Yes
Do digital health interventions reduce hospitalization and mortality in heart failure patients in low- and middle-income countries?
Digital health interventions provide a scalable and effective strategy to reduce hospitalizations and improve outcomes for heart failure patients in resource-constrained settings.
Supports integration of digital health into heart failure care in LMICs; extends randomized evidence to resource-limited settings.
Background Heart disease is the leading cause of death worldwide, and the growing prevalence of heart failure (HF) is a key contributor. Digital health (dHealth) modalities including mobile applications, telehealth, and wearables have been developed to improve HF care, though little is known about their impact in LMICs. Objective The aim of this review is to identify studies from LMICs that evaluated dhealth interventions for HF and determine the impact of those interventions on hospitalization and mortality. Methods Six databases were searched from January 1, 1990, to June 11, 2025. A total of 3,524 articles were screened (Cohen’s κ=69%). Included studies had a dHealth intervention, were a randomized controlled trial (RCT), occurred in a LMIC, and reported outcomes of interest. Risk of bias for RCTs was assessed using the Cochrane risk-of bias tool (RoB 2). Results Fifteen RCTs (N=4,568) with studies in Brazil (33.3%), China (26.7%), and Thailand (13.3%) were included. Interventions included telemonitoring, mobile apps, and wearables. The population averaged 61.1 years, 31.4% female, and 45.7% NYHA class III–IV. Random-effects meta-analysis showed dHealth reduced all-cause hospitalizations (RR 0.73, 95% CI 0.59–0.90), HF hospitalizations (RR 0.70, 95% CI 0.59–0.84), and all-cause mortality (RR 0.86, 95% CI 0.79–1.00); HF mortality was neutral (RR 0.64, 95% CI 0.37–1.11). Conclusions dHealth in LMICs lowers hospitalizations and may reduce all-cause mortality, though the benefit for HF mortality remains uncertain. These findings support broader dHealth adoption in LMICs to address HF burden.
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Nicely et al. (2026) conducted a meta-analysis in Heart Failure (n=4,568). Digital health interventions vs. Standard heart failure care was evaluated on All-cause hospitalizations (RR 0.73, 95% CI 0.59-0.90). Digital health interventions reduced all-cause hospitalizations (RR 0.73) and heart failure hospitalizations (RR 0.70) compared to standard care in heart failure patients in low- and middle-income countries.
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